National licensing exam for medical graduates essential

A letter to Malaysiakini by Dr. Chang Keng Wee, Master of the Academy of Medicine

Since the founding of the first medical school in Malaysia at the University of Malaya IN 1963, the Higher Education Ministry has to date approved the registration of medical programmes in 25 universities, 22 university colleges and five branch campuses of foreign universities.
Because of this, we are seeing an influx of medical graduates; giving rise to concerns whether certain programmes are of sufficient standard.
There are currently 34 medical schools compared to 9 and 12 medical schools in 2002 and 2007 respectively.
Sixteen new medical programmes commenced from 2009 to 2010.
There were 3,714 doctors who were provisionally registered (housemen) in 2011 compared to 1,534 in 2007.
ln general, the curricula in all of the programmes are satisfactory as this is monitored by the Malaysian Qualification Agency and the Malaysian Medical Council (MMC).
However, there is concern when it comes to the quality of students and lecturers.
Because of the increased number of medical seats available, students with unsuitable attitudes and aptitudes are gaining entrance in large numbers.
The introduction of minimum A level and STPM scores by the MMC in May 2011, for entry into local medical programmes is a small step in the right direction.
However, there is some doubt as to the standard of universities/ university colleges offering matriculation courses and offering direct entry into their medical programmes based on these non-standardised examinations.
Until 2011, high academic qualifications were the sole criteria for admission to all public medical schools except Universiti Sains Malaysia which required an interview as well.
Since 2011, the Malaysian Medical Council’s guidelines require all applicants to local medical schools to pass an interview to assess the applicant’s aptitude.
Although the minimum academic qualifications for entry into medical schools are prescribed by the MMC and the Malaysian Qualification Agency (MQA), there are still reports of noncompliance by some private medical schools.
There are also reports that some private medical schools take in more students than permitted.
With the mushrooming of medical schools, there is a great shortage of qualified lecturers, especially for the clinical disciplines.
Many private medical schools are now dependent on overseas lecturers who may not have recognised postgraduate qualifications for specialist practice in Malaysia.
Ideally, clinical lecturers should be in active practice, providing service in hospitals, so that the students can learn from their experience.
The ideal ratio of lecturer to student is 1:6-8 for preclinical students and 1:4 for clinical years.
The Health Ministry through the MMC constantly monitor and review foreign universities recognised under the second schedule of the Medical Act 1971, to ensure that quality and standards are maintained.
For those graduates from universities not on that list, qualifying examinations are prescribed by MMC prior to the candidate being eligible for registration.
This was reviewed by the Health Minister in early 2012 where candidates can sit for it in 16 universities for unlimited times, compared to the previous maximum of three attempts in only three universities.
The examination, which used to be the final year examination of Universiti Malaya, Universiti Kebangsaan Malaysia and Universiti Sains Malaysia, is now also conducted by 13 other universities.
What is of major concern is the uniformity of these examinations as far as standards are concerned.
This once again raises the issue of a national licensing examination for all medical graduates whether local or foreign ­trained.
An examination such as this will focus on the competencies of the candidate which are deemed essential for medical practice in Malaysia.
Such a system is practiced in many countries including the United States and some of our Asean neighbours.
Unless there is a standard benchmark, it will be difficult to assure the quality of medical graduates in this country.
The recent announcement that there is no limit to the number of attempts at the MQE raises fundamental questions about the quality of some of these doctors.
Where in the world can someone be permitted unlimited attempts at any examination, let alone in medicine?
Recently, a private college without an undergraduate medical programme announced that it intends to start postgraduate medical programmes.
This brings into question whether there is sufficient qualified clinical staff to train these postgraduate students and whether the environment of a private hospital can provide sufficient clinical material and hands on experience to adequately train a specialist.
Medical training, especially the training of a specialist is not about didactic lectures in lecture halls; the art of medicine is acquired by mentorship and apprenticeship.
Medical education should not he treated just like any other commodity; to be ventured into as a business for handsome profits.
Education of a doctor should be of the highest standard and from this to be derived quality patient care of international standard.
Perhaps it is timely to have a national medical manpower planning policy so as to rationalise the number of medical schools that this country needs.
More emphasis should be put on outcomes rather than process. The current accreditation system is very much process-driven.
Also with the number of medical schools it is very difficult for MMC/MQA to monitor all these processes in so many medical schools.
A well conducted, reliable and valid national assessment system will ensure that all graduates have the necessary competencies to work in a health care system of the 21st century.

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Malaysian physician, haematologist, blogger, web and tech enthusiast